Application For Child Care Leave

Name Of The Applicant :	Designation :
Mobile 1:	Mobile 2:
E-mail ID:	Name of the Circle :
School name :	Date of first joining in service :
Date of Completion of 2 years continous and satisfactory service :	Period of leave as applied for :	Days
Name Of the child :	Date of Birth of the child :
Is the Child among the two eldest children :	Any leave in credit (as on Date) :
Prefix of holidays, if any :	Suffix of holidays, if any :
Total Child Care Leave availed till date :	Date of returns from last leave & nature and period of that leave :
Application date :	Signature :